American Medical Association Family Medical Guide - American Medical Association [454]
A promising newer treatment for depression is the use of magnetic fields applied to the skull to stimulate electrical impulses in the brain. This technique has a success rate almost as high as that of ECT but does not trigger seizures, causes no pain, and does not require anesthesia.
Bipolar Disorder
People with bipolar disorder experience episodes of intense euphoria or mania that can, at times, alternate with periods of severe depression. The intensity of the disorder’s dramatic mood swings is different from the normal ups and downs that most people experience. Bipolar disorder tends to be cyclical, with the episodes of mania and depression interrupted by periods of normal mood. Manic states can occur suddenly or gradually and can last for days, weeks, or months. The first episode of mania usually occurs between ages 15 and 25. Stressful life events can trigger the onset of bipolar disorder in people who are genetically susceptible to developing the disorder.
Bipolar disorder affects about 1 percent of the population, striking men and women in equal numbers. The condition results from a combination of genetic and environmental factors. Almost 90 percent of affected people have a close relative with either bipolar disorder or depression. Additionally, an imbalance in brain chemicals and a deficiency in the production of some hormones (substances in the body that control key functions) may contribute to bipolar disorder. The sudden and intense mood swings that characterize bipolar disorder can seriously disrupt a person’s life by damaging relationships and negatively affecting job attendance and performance. Alcohol and drug abuse are common among people with bipolar disorder. Anxiety disorders, especially posttraumatic stress disorder (see page 720) and obsessive-compulsive disorder (see page 720), also commonly coexist in people with bipolar disorder.
Dysthymic Disorder
People who experience low-level symptoms of depression—either most of the time or intermittently—for 2 or more years have dysthymic disorder (also called dysthymia), a mild but persistent form of depression. Such people may not realize they are depressed, believing that they simply have a gloomy temperament. To others, people with dysthymic disorder may appear pessimistic, passive, introverted, and self-critical. They may have difficulty enjoying themselves and often are preoccupied with feelings of inadequacy and fear of failure. Other symptoms of dysthymic disorder include either poor appetite or overeating, sleep problems, low energy levels, poor concentration, and low self-esteem.
The cause of dysthymic disorder is not known, although it seems to carry the same inherited risk as major depression. Women are more frequently affected than men. The disorder may begin in childhood or adolescence, usually starting earlier than depression. People with dysthymic disorder may have difficulties in their relationships and usually have a negative perception of themselves. The principal danger of dysthymic disorder is that it can develop into major depression.
Dysthymic disorder often goes undiagnosed and untreated. Many people with dysthymic disorder fail to seek treatment because they think that feeling gloomy is normal. It is common for a person seeking help for the disorder to state that he or she has felt mildly depressed for years. If you or someone you know feels this way, discuss it with your doctor because a number of effective treatments can help you feel better.
Doctors frequently prescribe antidepressants (see page 712) to treat dysthymic disorder. Along with medication, doctors usually recommend